AR Revenue Cycle Specialist II 117634
AR Revenue Cycle Specialist II 117634
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$ 15 - 25
1 Vacancy
Job Description
We are seeking anAR Revenue Cycle Specialist II responsible for the collection of unpaid thirdparty claims and resolution of nonstandard appeals using various JHM applications and JHU/ PBS billing applications. Will conduct online research to locate information to resolve issues across different subspecialties and/or relating to highcost procedures. Communicates with payers to resolve issues and facilitate prompt payment of claims. Followup with insurance companies to collect outstanding accounts for which payment has not been received in response to the claims submission process either electronically or by paper. The Specialist will use a comprehensive knowledge of claims submission requirements for all payors in order to expedite payments. The Specialist will research and interpret medical policies regarding denials based on medical necessity. Will use a working knowledge of local coverage determinations (LCDs) to research and apply appropriately. Will mentor and advise junior specialists as appropriate.
Specific Duties and Responsibilities
- Uses A/R followup systems and reports to identify unpaid claims for collection/appeal.
- Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
- Review and update patient registration information (demographic and insurance) as needed.
- Resolves claim edits.
- Drafts and resolves nonstandard appeals.
- Researches medical policies to resolve denials based on medical necessity.
- Researches and applies LCDs.
- Resolves issues across different subspecialties and/or related to specialized complex or high cost
- procedures.
- Applies appropriate discounts / courtesies based on department policy.
- Prepares delinquent accounts for transfer to selfpay collection unit according to the followup matrix.
- Prints and mails claim forms and statements according to the followup matrix.
- Retrieves supporting documents (medical reports authorizations etc) as needed and submits to thirdparty payers.
- Appeals rejected claims and claims with low reimbursement.
- Confirm credit balances and gathers necessary documentation for processing refund.
- Identifies insurance issues of primary vs. secondary insurance coordination of benefits eligibility and any other issue causing nonpayment of claims.
- Contacts the payors or patient as appropriate for corrective action to resolve the issue and receive payment of claims.
- Monitor invoice activity until problem is resolved.
- Advises junior specialists as appropriate confirms and assumes responsibility for escalated issues.
- Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with nonpayment of claims and nonstandard appeals.
Professional & Personal Development
- Participate in ongoing educational activities.
- Keep current of industry changes by reading assigned material on work related topics.
- Complete three days of training annually.
Service Excellence
- Must adhere to Service Excellence Standards.
- Customer Relations
- SelfManagement
- Teamwork
- Communications
- Ownership/Accountability
- Continuous Performance Improvement.
Minimum Qualifications
- High School Diploma or graduation equivalent.
- Two years experience in a medical billing insurance followup processing or similar medical specialty environment.
- Additional education may substitute for required experience to the extent permitted by the JHU equivalency formula.
Classified Title: AR Revenue Cycle Specialist II
Role/Level/Range: ATO 40/E/02/OC
Starting Salary Range: $15.70 $25.25 HRLY $46800 targeted; Commensurate w/exp.
Employee group: Full Time
Schedule: MF 8:305:00
FLSA Status:NonExempt
Location:Hybrid/JH at Middle River
Department name: SOM DOM Billing
Personnel area: School of Medicine
Required Experience:
Unclear Seniority
Employment Type
Full Time
